Yogic intervention is proposed as a treatment for Alzheimer's disease based on previous research showing benefits of yoga for mood, cognition, and age-related conditions. The proposed study would use a randomized controlled longitudinal design to evaluate the effects of a 12-week integrated yoga therapy program including postures, breathing exercises and meditation on cognitive function, daily living abilities, neuropsychiatric symptoms, health literacy and depression in Alzheimer's patients, compared to a control group receiving conventional treatment. Outcomes would be assessed at baseline and monthly for 3 months, and at 6 months, to determine if yoga provides benefits beyond pharmaceutical interventions alone.

1. YOGIC INTERVENTION
IN ALZHEIMER’S
DISEASE
- Dr. Dhananjay Arankalle BNYS
National Institute of Naturopathy, Pune

2. BACKGROUND
• Medline search (1966 - 1999) AD has become nearly twice
as prevalent as vascular dementia (VaD) in Korea, Japan and
China since transition in early 1990s.
• Indian studies  AD and Vad both prevalent, whereas,
American and European studies AD to be more prevalent
than Vad.
(Acta Psychiatr Scand, 2001)
• 2006 - 26.6 million people worldwide.
• 2050 - 26.6 million X 4.
• The largest increase will occur in Asia. (from 48% to 59%)
(The number of Alzheimer's cases is expected to grow in Asia
from 12.65 million in 2006 to 62.85 million in 2050).
(Johns Hopkins University Bloomberg School of Public Health, 2007)

3. BACKGROUND contd…
• Mild to moderate AD (1 year treatment) – donepezil, galantamine,
memantine & rivastigmine – cognitive function – but QoL of both patient
& carer is not clear. (Cochrane Database Syst Rev, 2001, 2003, 2004)
• Sahaj yoga & depression - manipulation of information in the verbal
working memory; improvement in attention span and visuo-motor speed.
(Indian J Physiol Pharmacol, 2006)
• Mood improvement following yoga (state anxiety, depressive mood, and
subjective well-being). (J Psychol, 2003)
• IAYT & depression scores in older adults. (J Gerontol Nurs, 2007)
• Yoga & breathing exercises - ‘invigorating’ effect on perceptions of both
mental and physical energy and increased high positive mood. (J R Soc Med,
1993)
• Left nostril breathing - enhancement of spatial task performance (in both
males and females). (Int J Neurosci, 1993)

4. AIM
• To study the effects of integrated approach of
yoga therapy in patients suffering from AD on:
– Cognitive function
– Daily function
– Neuropsychiatric symptoms
– Functional health literacy
– Depression

5. METHOD Subjects
• Permission for recruitment of participants to be
sought from appropriate old-age homes and
clinical references from geriatric departments
of suitable hospitals and/or OPDs.
• Stratification  Age (60-65, 65-70, 70-75, 75-
80, 80-85, 85+), socio-economic (Poor,
Moderate, Good), Gender (M, F)

6. METHOD Subjects
• INCLUSION CRITERIA – based on the
standard diagnostic criteria laid by the
‘National Institute for Neurological and
Communicative Disorders and Stroke-
Alzheimer's Disease and Related Disorder
Association’ (NINDS - ADRDA)
(Lancet neurol, 2007)

7. METHOD Subjects
EXCLUSION CRITERIA
• History
– Sudden onset
– Early occurrence of : gait disturbances, seizures, behavioural changes
• Clinical features
– Focal neurological features (hemiparesis, sensory loss, visual field
deficits), Early extrapyramidal signs
– Advanced AD
• Other medical disorders
– Non-AD dementia
– Major depression
– Cerebrovascular disease
– Toxic and metabolic abnormalities, all of which may require specific
investigations

8. METHOD Design
• Longitudinal stratified randomized control
study
• Effect size: Based on previous studies
1 2 3 6
• YOGA Pre CT + Intervention (12 weeks)
1 2 3 6
• CONTROL Pre Conventional treatment (CT)

9. METHOD Intervention
• Postures
40 min - morning
• Breathing exercises
• Meditation  20 mins – evening
• 1 hour session – thrice a week – for 12 weeks
• ASSESSMENT  Monthly for 3 months; 6
months.

10. PARAMETERS
• Cognitive function  MMSE
• Daily function  ADL & IADL
• Neuropsychiatric symptoms  NPI-Q
CG
• Functional health literacy  TOFHLA
• Depression  GDS
• DATA ANALYSIS  Statistician/SPSS s/w

11. REFERENCES
• Suh GH, Shah A. “A review of the epidemiological
transition in dementia - cross-national comparisons of the
indices related to Alzheimer's disease and vascular
dementia”. Acta Psychiatr Scand. 2001 Jul;104(1):4-11.
• Johns Hopkins University Bloomberg School of Public
Health (2007, June 11). Alzheimer's Disease To Quadruple
Worldwide By 2050. ScienceDaily Retrieved December 12,
2008,from(http://www.sciencedaily.com/releases/2007/06/07
0610104441.htm )
• JNetz Y, Lidor R. “Mood alterations in mindful versus
aerobic exercise modes”. J Psychol. 2003 Sep;137(5):405-19
• Krishnamurthy MN, Telles S. “Assessing depression
following two ancient Indian interventions: effects of yoga
and ayurveda on older adults in a residential home”. J
Gerontol Nurs. 2007 Feb;33(2):17-23

12. REFERENCES contd…
• Wood C. “Mood change and perceptions of vitality: a comparison of the effects
of relaxation, visualization and yoga”. J R Soc Med. 1993 May;86(5):254-8
• Jella SA, Shannahoff-Khalsa DS. “The effects of unilateral forced nostril
breathing on cognitive performance”. Int J Neurosci. 1993 Nov;73(1-2):61-8
• Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P,
Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K,
O'brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ,
Scheltens P. Research criteria for the diagnosis of Alzheimer's disease: revising
the NINCDS-ADRDA criteria. Lancet Neurol. 2007 Aug;6(8):734-46.
• Areosa Sastre A., Sherriff F. “Memantine for Dementia”. Cochrane Database
Syst Rev. 2003; (3):CD0003154.
• Birks JS, Harvey R. “Donepezil for Dementia due to Alzheimer’s disease”.
Cochrane Database Syst Rev. 2003; (3):CD001190.
• Olin J, Schneider L. “Galantamine for Alzheimer’s disease”. Cochrane
Database Syst Rev. 2001; (4):CD001747.

13. THANK YOU